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what are the methods for pre-natal diagnosis

AFP, triple marker screen, quadruple marker screen, chorionic villus sampling, ultrascreen, US, amniocentesis

what is maternal serum alpha fetoprotein (MS-AFP)

produced in fetal liver cells, found in ammniotic fluid and meternal blood

when is AFP found

16-20 weeks

what does elevated AFP mean

neural tube defects (NTD)

what does decreased AFP mean

trisomy 21/18

what is a triple marker screen

Three blood tests (MS-AFP, estriol, B hCG

when is triple marker screen done

15-20 weeks

why do triple marker screen

improves detection over AFP alone: same consequences as AFP

what is a quadruple screen

inhibin-A + MS-AFP, estriol, B hCG (triple screen); hormone in blood made by placenta

when is a quadruple screen done

15-20 weeks

why do a quadruple screen

predicts adverse pregnancy outcome, small baby, still birth

when is chorionic villus sampling done

10-12 weeks

how is chorionic villus sampling done

Catheter passed through cervix into uterus to developing placenta utilizing ultrasound

what is an ultrascreen

Measures blood protein levels and ultrasound for nuchal translucency (thickness of skin on back of fetal neck

when is an ultrascreen done

11-14 weeks

what does ultrascreen test for

downs, trisomy 18

when can you visualize IUP with US

5 weeks

what is US used for

detects anomalies, twins, placenta location, abnormal pregnancy, gestational age

what is gestational age dependent on

Abdominal circumference, Head circumference, Biparietal diameter of head, Femur length, Crown to rump length (first trimester)

when is amniocentesis done

15-18 weeks

how is amniocentesis done

needle passed thorugh mothers lower abdomen into amniotic cavity

what are the two types of fetal monitoring

internal and external

internal fetal monitoring

fetal scalp electrode, xervix must be dilated and membranes ruptured, high quality recordings.

external fetal monitoring

transducer on mother's abdomen. Does not require cervical dilation or membrane rupture. FHR quality varies with position and maternal obesity

what is normal HR of fetus


what is marked change in fetal heart rate

greater than 25

what are periodic changes

accelerations and decelerations in FHR associated with contractions

what are accelerations

Seen with fetal movement or stimulation. Abrupt
increase in fetal heart rate above baseline

what are early deceleration

Decrease in response to contractions.; Onset with onset of contractions, duration is
length of contraction

why do early deceleration happen

Due to fetal head compression during contraction resulting in fetal vagal stimulation

what is variable deceleration

Decrease in FHR not associated with contractions

why do variable deceleration happen

umbilical cord compression

what is late deceleration

Gradual onset of decreased FHR and gradual return to normal

why does late deceleration happen

uteroplacental insufficency

what is not assuring fetal scalp pH

less than 7.2

what is a non stress test

Transducer placed on mother's abdomen to record FHR and reactivity

what is non reactive NST

Accelerations not present. Fetus can be compromised, asleep, immature, or sedated

what do you do with non reactive NST

wake fetus with vibro-acuoustic stimulation

what is a contraction stress test (CST)

Uterine contractions decrease blood flow to the placenta. Need spontaneous contractions or contractions induced by oxytocin.

what is a negative CST

No late decelerations in presence of contractions

what is a positive CST

repetitive late decelerations

what is a biophysical profile

5 parameters, two points each: NST reactivity, extremity tone, chest wall movements, gross body movements, amniotic fluid volume

what are the results of a biophysical profile

8-10 = good: 4-6 = deliver if greater than 36 weeks

what is fetal scalp sampling

Used in labor if question of fetal well being;

how is fetal scalp sampling done

cone placed in vagina to visualize fetal head; prick scalp and draw blood

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